On the treatment of high unilateral congenital hip dislocation in older children: Minimizing the inequality of limb length

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Abstract

BACKGROUND: Treatment of high congenital hip dislocation in older children remains controversial in terms of the choice of the method of reducing the femoral head to the level of the acetabulum. In most cases, significant shortening of the hip is performed to eliminate dislocation, which leads to secondary deformities.

AIM: This study aimed to evaluate the results of treatment of high hip dislocation in older children, in which pre-reduction skeletal traction and economical shortening of the femoral segment are rationally combined to lower the femoral head.

MATERIALS AND METHODS: From 2011 to 2021, we observed 13 patients aged 5–13 years with grade 4 high unilateral congenital hip dislocation according to the international Tonnis classification.

RESULTS: The treatment results were traced for 1–9 years. When assessing hip joint function according to McKay criteria, excellent and good results were obtained in 84.6% of the patients. X-ray evaluation by Severin also included 84.6% in groups 1 and 2. Signs of avascular necrosis of the femoral head according to the criteria of Kalamchi and MacEwen were detected in four patients (group 1, n = 2; group 2, n = 1; group 3, n = 1). The difference in the length of the n/limbs in eight patients was 1.5 cm on average, and in the remaining children, a clinically insignificant asymmetry was observed in the length of the n/limbs, i.e., 0.5–0.7 cm.

CONCLUSIONS: The choice of the method of surgical correction of high hip dislocation largely depends on the age of the child. In children aged >5 years, with a significant displacement of the femoral head and limb shortening, a combination of reduction methods is rational, i.e., use of preoperative skeletal traction with economical shortening of the femoral segment, open reduction, and correction of the acetabulum. The optimal combination of the distraction method and surgical correction makes it possible to achieve successful reduction and a good functional result.

About the authors

Oleg V. Kozhevnikov

N.N. Priorov Central Research Institute of Traumatology and Orthopedics

Email: 10otdcito@mail.ru
ORCID iD: 0000-0003-3929-6294
SPIN-code: 9538-4058
ResearcherId: A-8380-2019

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Moscow

Svetlana E. Kralina

N.N. Priorov Central Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: Kralina_s@mail.ru
ORCID iD: 0000-0001-6956-6801
SPIN-code: 9178-0184

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Moscow

Anatoly S. Kuznetsov

N.N. Priorov Central Research Institute of Traumatology and Orthopedics

Email: anatolymond@gmail.com
ORCID iD: 0000-0003-2790-1063

MD, PhD student

Russian Federation, Moscow

Inna V. Gribova

N.N. Priorov Central Research Institute of Traumatology and Orthopedics

Email: grinna@bk.ru
ORCID iD: 0000-0001-7323-0681
SPIN-code: 5618-4231

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Radiographs of patient T., 13 years old, with high congenital dislocation of the left hip: a, before the treatment of iliac dislocation, the head of the left femur is located at the iliac wing level, with discontinuity of the Shenton line of 6 cm, acetabular index of 60°, angle of vertical inclination of the cavity 68°, caput–collum–diaphyseal angle of 125°, and anteversion of the femoral neck of 50°; b, stage 1 of surgical treatment included shortening detorsion osteotomy of the femur with the imposition of a distraction apparatus on the pelvis and left thigh. The resected bone fragment (2.5 cm) is located in the subcutaneous tissue in the acetabular zone; c, X-ray image 2 weeks after the distraction start. The head of the left femur was reduced to the level of the lower edge of the acetabulum; d, in stage 2 of surgical treatment, the distraction apparatus was dismantled, and open reduction of the femoral head into the acetabulum and triple osteotomy of the pelvis on the left with transposition of the acetabulum were performed

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3. Fig. 2. Patient’s appearance at the stage of treatment with the MKC wire-rod distraction apparatus

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4. Fig. 3. Patient S. with high congenital dislocation of the left femur at the stages of treatment: a, radiograph at the age of 7 years before treatment revealed iliac dislocation of the left femur, the femoral head is located at the level of the iliac wing, and the discontinuity of the Shenton line is 5 cm; b, radiograph immediately after the staged treatment with the restoration of ratios in the left hip joint; c, X-ray result of treatment at the age of 15 years: grade IA according to the Severin classification; d, functional result of treatment (age 15 years): group “excellent” according to McKay’s criteria

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5. Fig. 4. Patient T. with high congenital dislocation of the right hip, grade I according to the Kalamchi/MacEwen classification: a, b, radiographs at the age of 8 years, showing iliac dislocation of the head of the right femur and discontinuity of the Shenton line 6 cm; c, radiograph at the stage of surgical treatment, immediately after the femoral head reduction, with fixation in the distraction apparatus; d, radiograph 6 months after reduction, the femoral head is centered in the cavity, its structure is heterogeneous, and its sphericity is preserved; e, radiograph 2 years after treatment (age 10 years); f, radiograph 5 years after treatment (age 13 years), grade I according to the Kalamchi/MacEwen classification, grade II according to the Severin classification; g, functional result of treatment (age 13 years), “good” group according to McKay’s criteria

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6. Fig. 5. Patient K. with high congenital dislocation of the left hip, grade III according to the Kalamchi/MacEwen classification: a, b, radiographs at the age of 12 years showing iliac dislocation of the left hip and discontinuity of the Shenton line of 6 cm; c, radiograph 2 months after surgical treatment; d, radiograph 3 years after treatment (age 15 years), showing aseptic necrosis of the femoral head with preservation of its sphericity, short femoral neck, grade III according to the Kalamchi/MacEwen classification and grade III according to the Severin classification; e, functional result of treatment (age 15 years); “satisfactory” group according to McKay’s criteria

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Copyright (c) 2022 Kozhevnikov OV, Kralina SE, Kuznetsov AS, Gribova IV


 


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